Provider Demographics
NPI:1649810623
Name:CUERVO, JEANINE MARIE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:MARIE
Last Name:CUERVO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15543 SW 55TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4176
Mailing Address - Country:US
Mailing Address - Phone:786-539-8956
Mailing Address - Fax:
Practice Address - Street 1:15543 SW 55TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4176
Practice Address - Country:US
Practice Address - Phone:786-539-8956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant